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Oral health-related behaviours do not mediate the effect of maternal education on adolescents' gingival bleeding: A birth cohort study.

ABSTRACT: To test whether maternal education has a direct effect on gingival bleeding in adolescents aged 12 and to assess whether oral health behaviours over time mediate that association.Two oral health studies nested in the 1993 Pelotas (Brazil) birth cohort study were carried out in participants aged 6 (n = 359) and 12 years (n = 339). The proportion of teeth with bleeding on probing (BOP) and the median number of teeth with gingivitis at age 12 were recorded. Maternal education at birth was the exposure. Toothbrushing frequency and dental visit at ages 6 and 12 years were investigated as mediators of the association between maternal education at birth and gingival bleeding. Time-varying family income through childhood and adolescence was included as later confounder. Paternal education was taken as baseline confounder. The controlled direct effect (CDE) of maternal education at child's birth on gingival bleeding at age 12 was estimated using marginal structural models (MSM). Additionally, path analysis was employed to estimate standardized direct, indirect and total effects of maternal education at birth on gingival bleeding.Adjusted analyses using MSM showed that adolescents whose mothers had <8 years of education had 3.82 higher risk of having teeth with gingival bleeding above the median (rate ratio RR 3.82; 95% CI: 1.68-8.19). Low maternal education doubled the proportion of gingival bleeding at age 12 not mediated by dental visit and toothbrushing frequency (RR 1.99; 95% CI: 1.52-2.60). Path analysis revealed that maternal education had a direct effect on gingival bleeding independently of the mediators.The pattern of oral health behaviours does not explain the association between mother's education and adolescent's gingival bleeding. Individual-based approaches focused on oral health-related behaviours tend to fail to prevent gingival bleeding.

SUBMITTER: Peres MA

PROVIDER: S-EPMC5887883 | biostudies-other | 2018 Apr

REPOSITORIES: biostudies-other

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Oral health-related behaviours do not mediate the effect of maternal education on adolescents' gingival bleeding: A birth cohort study.

Peres Marco A MA Nascimento Gustavo G GG Peres Karen G KG Demarco Flavio F FF Menezes Ana B AB

Community dentistry and oral epidemiology 20171127 2

<h4>Objectives</h4>To test whether maternal education has a direct effect on gingival bleeding in adolescents aged 12 and to assess whether oral health behaviours over time mediate that association.<h4>Methods</h4>Two oral health studies nested in the 1993 Pelotas (Brazil) birth cohort study were carried out in participants aged 6 (n = 359) and 12 years (n = 339). The proportion of teeth with bleeding on probing (BOP) and the median number of teeth with gingivitis at age 12 were recorded. Matern ...[more]

PMID: 29178456

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Project description:ObjectivesObservational studies have identified associations between periodontitis and adverse pregnancy outcomes, but randomised controlled trials evaluating the efficacy of periodontal therapy have yielded inconsistent results. Few studies have explored relationships between gingival inflammation and these outcomes or been conducted in rural, low-income communities, where confounding risk factors differ from other settings.MethodsWe conducted a community-based, prospective cohort study with the aim of estimating associations between the extent of gingival inflammation in pregnant women and incidence of preterm birth in rural Nepal. Our primary exposure was gingival inflammation, defined as bleeding on probing (BOP) ≥10%, stratified by BOP <30% and BOP ≥30%. A secondary exposure, mild periodontitis, was defined as ≥2 interproximal sites with probing depth (PD) ≥4 mm (different teeth) or one site with PD ≥5 mm. Our primary outcome was preterm birth (<37 weeks gestation). We used Poisson regression to model this relationship, adjusting for potential confounders.ResultsOf 1394 participants, 554 (39.7%) had gingival inflammation, 54 (3.9%) mild periodontitis and 197 (14.1%) delivered preterm. In the adjusted regression model, increasing extent of gingival inflammation was associated with a non-significant increase in risk of preterm birth (BOP ≥30% vs no BOP: adjusted relative risk (aRR) 1.37, 95% CI: 0.81 to 2.32). A secondary analysis, stratifying participants by when in pregnancy their oral health status was assessed, showed an association between gingival inflammation and preterm birth among women examined in their first trimester (BOP ≥30% vs no BOP: aRR 2.57, 95% CI: 1.11 to 5.95), but not later in pregnancy (BOP ≥30% vs no BOP: aRR 1.05, 95% CI: 0.52 to 2.11).ConclusionsGingival inflammation in women examined early in pregnancy and poor oral hygiene behaviours were risk factors for preterm birth. Future studies should evaluate community-based oral health interventions that specifically target gingival inflammation, delivered early in or before pregnancy, on preterm birth.Trial registration numberNepal Oil Massage Study, NCT01177111.

Project description:ObjectiveThis study investigates the associations between maternal health and health-related behaviours (nutrition, physical activity, alcohol consumption and smoking) both during pregnancy and up to 15 months from childbirth and children's health outcomes during infancy and adolescence (general health, presence of a chronic illness, and physical health outcome index).MethodsThis study used Wave 1 (2004) and Wave 7 (2016) data from the Longitudinal Survey of Australian Children (LSAC). We measured mothers' general health, presence of a medical condition during pregnancy and mental health during pregnancy or in the year after childbirth. We subsequently measured the children's general health, presence of a medical condition, and physical health outcome index at ages 0-1 (infancy) and 12-13 (adolescence). Binary logistic and linear regression analyses were performed to examine the association between the mothers' health-related variables and their children's health.ResultsOur results showed that poor general health of the mother in the year after childbirth was associated with higher odds of poor health in infants and adolescents in all three dimensions: poor general health (OR: 3.13, 95% CI: 2.16-4.52 for infants; OR: 1.39, 95% CI: 0.95-2.04 for adolescents), presence of a chronic condition (OR: 1.47, 95% CI: 1.19-1.81 for adolescents) and lower physical health score (b = -0.94, p-value <0.05 for adolescents). Our study also revealed that the presence of a chronic condition in mothers during pregnancy significantly increased the likelihood of the presence of a chronic condition in their offspring during infancy (OR: 1.31, 95% CI: 1.12-1.54) and during adolescence (OR: 1.45, 95% CI: 1.20-1.75). The study found that stressful life events faced by mothers increase the odds of poor general health or any chronic illness during adolescence, while stress, anxiety or depression during pregnancy and psychological distress in the year after childbirth increase the odds of any chronic illness during infancy.ConclusionsThe present study found evidence that poor maternal physical and mental health during pregnancy or up to 15 months from childbirth has adverse health consequences for their offspring as measured by general health, presence of chronic health conditions, and physical health index scores. This suggests that initiatives to improve maternal physical and mental health would not only improve child health but would also reduce the national health burden.

Project description:Study questionIs oral contraceptive use around the time of pregnancy onset associated with an increased risk of major birth defects?MethodsIn a prospective observational cohort study, data on oral contraceptive use and major birth defects were collected among 880,694 live births from Danish registries between 1997 and 2011. We conservatively assumed that oral contraceptive exposure lasted up to the most recently filled prescription. The main outcome measure was the number of major birth defects throughout one year follow-up (defined according to the European Surveillance of Congenital Anomalies classification). Logistic regression estimated prevalence odds ratios of any major birth defect as well as categories of birth defect subgroups.Study answer and limitationsPrevalence of major birth defects (per 1000 births) was consistent across each oral contraceptive exposure group (25.1, never users; 25.0, use >3 months before pregnancy onset (reference group); 24.9, use 0-3 months before pregnancy onset (that is, recent use); 24.8, use after pregnancy onset). No increase in prevalence of major birth defects was seen with oral contraceptive exposure among women with recent use before pregnancy (prevalence odds ratio 0.98 (95% confidence interval 0.93 to 1.03)) or use after pregnancy onset (0.95 (0.84 to 1.08)), compared with the reference group. There was also no increase in prevalence of any birth defect subgroup (for example, limb defects). It is unknown whether women took oral contraceptives up to the date of their most recently filled prescription. Also, the rarity of birth defects made disaggregation of the results difficult. Residual confounding was possible, and the analysis lacked information on folate, one of the proposed mechanisms.What this study addsOral contraceptive exposure just before or during pregnancy does not appear to be associated with an increased risk of major birth defects.Funding, competing interests, data sharingBMC was funded by the Harvard T H Chan School of Public Health's Maternal Health Task Force and Department of Epidemiology Rose Traveling Fellowship; training grant T32HD060454 in reproductive, perinatal, and paediatric epidemiology and award F32HD084000 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and grant T32CA09001 from the National Cancer Institute. The authors have no competing interests or additional data to share.

Project description:All subjects were recruited at Centennial Women?s Hospital and the Perinatal Research Center in Nashville, TN beginning in 2003. Pregnant women were enrolled during their first clinical visit after obtaining informed consent as described previously. Demographic and clinical data specific to the fetus was collected from clinical records. Gestational age of the neonate was determined by maternal reporting of the last menstrual period and corroboration by ultrasound dating. Accurate knowledge of gestational age (GA) is essential for proper monitoring and care of neonates. However, accurate GA measures are often not available. DNA methylation has previously been shown to associate with GA, and has been used to accurately predict chronological age in adults. In the current study, we examine whether DNA methylation in cord blood can be used to predict gestational age at birth. Results: We found that GA can be accurately predicted from DNA methylation of neonatal cord blood and blood spot samples (DNAm GA), using 148 CpG sites selected through elastic net regression in six training datasets (N=207). We evaluated predictive accuracy in six testing datasets (N=1,202), and found that the accuracy of DNAm GA meets or exceeds accuracy of gestational age estimates based on established methods. We also found an increased DNAm GA, relative to clinical GA, was associated with increased birthweight percentile (p=.00057), adjusting for GA, sex, and ancestry, suggesting that DNAm GA could represent developmental age more accurately than clinical estimates of GA. Conclusions: Further development of this predictor could provide a method of accurate neonatal estimation of GA for use in resource-limited populations, or in cases where GA cannot be estimated clinically. When clinical estimates are available, the predictor can be used to test hypotheses related to developmental age and other early life circumstances, and may provide increased accuracy beyond clinical estimates.

Dataset Information

Oral health-related behaviours do not mediate the effect of maternal education on adolescents' gingival bleeding: A birth cohort study.

Publications

Oral health-related behaviours do not mediate the effect of maternal education on adolescents' gingival bleeding: A birth cohort study.

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